Appendix 1 - Nicotine Replacement Therapy (NRT)

Does the patient want to stop smoking?

If the patient does want to stop smoking then refer them to Quit Your Way (preferred method of referral is via TrakCare). The Stop Smoking advisor will:

1. Assess patient's motivation to stop smoking.
2. Assess nicotine dependence.
3. Discuss suitability for NRT and initiate via prescribing staff.
4. Continue to monitor and support patient for length of hospital stay.
5. As part of patient discharge plan, arrange follow-up support by referring to community stop smoking advisor and linking to community pharmacy service for NRT for up to 12 weeks.
6. Ensure all patients on the stop smoking programme are prescribed NRT during their hospital stay and supplied with 1 week of NRT on discharge.

If the patient does not want to stop smoking then assess whether they need symptomatic relief for acute nicotine withdrawal.

• If symptomatic relief is not required then advise patient regarding the health risk of continued smoking and the benefits of stopping smoking. Also give Quit Your Way Services information.
• If symptomatic relief is required then prescribe Nicotinell^® patch:

• • If >20 cigarettes/day smoked – 21mg patch
  • If <20 cigarettes/day smoked – 14mg patch

The manufacturer recommends 24 hour use of the patch to avoid morning cravings but it can be used for 16 hours to avoid sleep disturbance. Add order note as "Note to Prescriber" on HEPMA "For Acute Withdrawal only" and review need daily.

• Discontinue prescription on discharge. If patient wishes to make a quit attempt, refer to Quit Your Way before discharge (preferred method of referral is via TrakCare)

Guidance on psychotropic drugs affected by changes in smoking status, can be found here.

N.B. All pregnant women should be referred to Quit Your Way via Badgernet.